Primary Care Research Institute, State University of New York at Buffalo, Buffalo, New York, USA

Dr R Singh, Primary Care Research Institute, State University of New York at Buffalo, 462 Grider Street, Buffalo, NY 14215,
USA; rs10{at}buffalo.edu

Accepted 18 May 2008

Abstract

Objective: To evaluate the performance of a trigger tool for identifying adverse drug events (ADEs) among older adults in ambulatory
primary care practices.

Methods: Manual 12-month retrospective chart review at six practices using a 39-item trigger tool. Patients aged 65 or above with
cardiovascular diagnoses were included. Charts with triggers underwent detailed review by a physician and pharmacist to identify
ADEs.

Results: Of 1289 charts reviewed, 645 (50%) had at least one trigger. A random sample of 383 of these charts underwent further review
(mean 64 charts per practice). Among the 908 triggers in these charts, 232 were deemed to represent ADEs, of which 92 were
deemed preventable and 30% of these were severe. The most common triggers and their positive predictive values (PPVs) for
ADEs were “Medication stop” (26.3%), “Hospitalisation” (21.8%) and “Emergency Room” visit (14.9%). Only nine of the triggers
had PPVs >5%. These nine triggers accounted for 94.4% (219/232) of the ADEs detected.

Discussion: Trigger tools have a potential role in driving quality improvement in ambulatory primary care. In our study using a 39-item
ADE trigger tool, most triggers had very low PPVs. Nine of the 39 triggers accounted for 94.4% of ADEs detected, suggesting
the possibility of a much briefer tool. Practical issues related to adoption of such tools by practising physicians should
be further explored.

Footnotes

Funding: Agency of Healthcare Research and Quality (R21HS014867).

Competing interests: None.

Ethics approval: Ethics approval was obtained from the Social and Behavioral Sciences Institutional Review Board of the State University of
New York at Buffalo